change in the age of disruption: emergent change
TRANSCRIPT
@HelenBevan @SteveFairman1 #cmidisruptSource of image:
Buildingchangetrust.org
Helen Bevan@HelenBevan
Steve Fairman@SteveFairman1
#cmidisrupt
Emergent change
@HelenBevan @SteveFairman1 #cmidisrupt
Our three questions• What is emergent change and why is it so
important to understand?• How can we support a move to change that is
truly demand-led?• Where does leadership and “change
management” fit in?
In the context of the
English National Health
Service!
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The English NHS: facts and figures• The world’s largest publically funded health
system• Provides comprehensive healthcare to 54
million people• Sees a million patients every 36 hours• Funded by direct tax• It’s free at the point of use• Provides 95% of the healthcare in England
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From a meeting yesterday: NHS Emergency Departments
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The NHS is the 5th biggest employer on the globe
Source: BBC
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Where are we?• Dramatic improvements in care over 15 years• Only health system globally to manage five years
of little/no real growth without increasing charges, cutting services or cutting staff
• Ranked the highest performing health system of 11 industrialised countries (Commonwealth Fund, USA)
Source: 5 Year Forward Year (2014) NHS England http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
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Where are we?The dominant NHS approach [to leadership] is
typified by laying down demanding targets, leading from the front, often being reluctant to delegate,
and collaborating little – and is the consequence of the health service focusing on process targets, with
reward dependent on meeting them.
Source: Kings Fund Leadership for engagement and improvement in the NHS http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-engagement-improvement-nhs-final-review2012.pdf
“
“
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Where are we?
Three giant challenges:• The health and wellbeing gap• The care and quality gap• The funding and efficiency gap
Source: 5 Year Forward Year (2014) NHS England http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
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The Dependency Ratio is rising alarmingly
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The National Health Service is the closest thing the English have to a religion, with those who
practice in it regarding themselves as a priesthood. This makes it quite extraordinarily
difficult to reformNigel Lawson, politician
“ “
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Source: @NHSChangeDay
Can I, dare I?
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Between us, we bring more than 40 years experience of leading change in health and care...…..
“It has been positivelyreviewed and reported in the nursing
& healthcare press and its implementation is proven to produce significant savings in
productivity & efficiency”White et al 2013
“Contributed
to a 51% reduction in
antipsychotic prescribing to
people with dementia”
Manchester Business
School
One of the most widely adopted and impactful improvement programmes in the history of the NHS; “releasing
time to care”, typically 10-20% of the time of clinical professionals. The changes were adopted by 78% of NHS hospital wards, 68% of mental health
wards, 54% of NHS operating theatres and 49% of community health teams across England (SHA statistics) as well as 44 territories
across the globe
New Zealand: 19% of time“released to care”
Oregon USA: multi-factorial improvements
Scotland: “20% of time
released to care”
A significant,positive impact on staff
engagement
Irish research: the effects were
sustained over time
Statistically significant positive effect on EVERY dimension of impact at both individual & organisational level
Tangible ROI: both visible
& invisible benefitsExternal
evaluators
@HelenBevan @SteveFairman1 #cmidisruptImage from: @TheWorldStories
@HelenBevan @SteveFairman1 #cmidisruptImage from: @TheWorldStories
@HelenBevan @SteveFairman1 #cmidisrupt
Is your change process a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf
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We have a lot of cathedrals
Source: Sewell (2015) : Stop training our project managers to be process junkies
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SEISMIC SHIFTS
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Kinthi Sturtevant, IBM 13th
annual Change Management Conference
June 2015
We rarely see two, three or four year change projects anymore. Now it’s 30-60-90 day change
projects
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DIGITALCONNECTION
SEISMIC SHIFTS
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Empower your staff to be the voice of the organisation. They’ve got audience & credibility
Employees have 10x more connections than corporate social accounts
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Work complexity
SEISMIC SHIFTS
DIGITALCONNECTION
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DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexity
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“In a connected world, power no longer emanates from the top of the heap, but the centre of the
network.”Greg Satell, 2015
Greg Satell: http://www.digitaltonto.com/2015/how-power-is-shifting-from-corporations-to-platforms/
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DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexityChange from the edge
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http://www.slideshare.net/Openpolicymaking/policy-lab-slide-share-introduction-final
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Starts on the fringe (at the edge)
Starts with the activistsGary Hamel
always
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Why go to the edge?
“Leading from the edge brings us into contact with a far wider range
of relationships, and in turn, this increases our potential for diversity in terms of thought, experience and
background. Diversity leads to more disruptive thinking, faster
change and better outcomesAylet Baron
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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship
@HelenBevan @SteveFairman1 #cmidisruptFor more information/explanation visit: The Collaboration Pyramid revisited
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Three types of levers for large scale change
‘Prod mechanisms’ targets
performance management
price & payment incentives regulation
competition
‘Proactive support’
relies on building ‘intrinsic motivation’ in
staff to make the right changes to
improve
‘People focused’ education and training
national contractsprofessional regulation
clinical quality standards
Type one:
Type two: Type three:
Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015
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Three types of levers for large scale change
‘Prod mechanisms’ targets
performance management
price & payment incentives regulation
competition
‘Proactive support’
relies on building ‘intrinsic motivation’ in
staff to make the right changes to
improve
‘People focused’ education and training
national contractsprofessional regulation
clinical quality standards
Type one:
Type two: Type three:
Source: Health Foundation report Constructive comfort: accelerating change in the NHS 2015
Less than 10%of the potential
for improvement
at system level can be
delivered through type one change
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“In a world of mounting performance pressure, [organisations and change processes] need to evolve…the most successful will be those that
evolve into movements.
Success will be determined by their ability to mobilise, inspire and support an
ever-expanding array of participants extending far beyond their own four walls”
John Hagel, SXSW 2015http://www2.deloitte.com/us/en/pages/center-for-the-edge/articles/john-hagel-at-sxsw.html
@HelenBevan @TheEdgenhs #EdgeTalks @HelenBevan @Jodi Olden #EdgeTalks
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The power of the platform“Facebook, YouTube, Twitter and their lesser cousins have proved the power of the platform. They have shown that if
your average 21st century citizen is given the tools to connect and the freedom to create, they will do so with
enthusiasm, and often with an originality that blindsides the so-called creative industries. …..
Good leadership is no longer about ‘taking charge’ or imposing a strategic vision but about creating the
platforms that allow others to flourish and create” Ashoka
http://www.virgin.com/unite/entrepreneurship/what-does-leadership-mean-in-the-21st-century
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@HelenBevan @SteveFairman1 #cmidisrupt
• systematic “change management”
• too often, leaders prescribe outcome and method of change in a top-down way
• change is experienced by people at the front line as “have to” (imposed) rather than “want to” (embraced)
Change Programmes
• everyone (including service users and families) can help tackle the most challenging issues
• value diversity of thought• connect people, ideas and
learning• Role of formal leaders is to
create the conditions and get out of the way
Change Platforms
“Tear down the walls”
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“A space (physical or virtual) that is created so people get the choice and opportunity to collaborate without boundaries to achieve a common purpose, tackle a challenge or improve a situationChange platforms tackle silo thinking and other barriers to the exchange of knowledge. They enable a diverse group of people to come to the table, share ideas, insight and learned experience, co-create solutions and launch experiments. Platforms thrive on trust, relationships and the collisions of minds. They build energy for change.
What is a change platform?
Definition by @JodiOlden & @HelenBevan 2015
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“Change comes naturally when individuals have a platform that allows them to identify shared interests and to brainstorm solutions.”
Gary Hamel & Michele Zanini, 2014Build a change platform not a change program
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Joy’s Law: No matter who you are, most of the smartest people work for someone else
Bill Joy, Sun Microsystems
“It’s become a kind of ‘Joy’s Law’ for the networked era—the best resources and capabilities always lie somewhere else.”
Greg Satellhttp://www.digitaltonto.com/2015/4-things-you-should-know-about-platforms/?
ct=t%28Why_Some_Movements_Succeed_5_31_2015%29
Platforms give access to resources
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Evolving kinds of change platforms:
They overlap!
1. Connecting platforms
2. Mobilising platforms
3. Learning platforms
4. Knowledge platforms
5. Crowdsourcing platforms
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Platform principles have long been part of change practice
• Building on traditions in the field of organisation development of communities of interest and communities of practice
• Technology enables us to connect more widely and at greater speed
Source of image: Socialserviceinstitute.sg
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Example platforms from our world
Source of image: @JenniferClemo
@HelenBevan @SteveFairman1 #cmidisrupthttp://biggerboat.org/exploring-moodocs/
MOODOCs(Massive, Online, Open, Disease Oriented Communities)
60,000 online diabetes communities and
around 80 million online patient communities
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https://www.youtube.com/watch?v=CMDKkTuLUHw
http://www.breakdengue.org/
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The Academy of Fabulous NHS Stuff
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Horizons Team: All our work is via change platforms
Source of image: @JenniferClemo #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
@HelenBevan @SteveFairman1 #cmidisrupt #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
@HelenBevan @SteveFairman1 #cmidisrupt #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
@HelenBevan @SteveFairman1 #cmidisruptSource: http://www.slideshare.net/alwynlau/learning-theories-learner-needs
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1. Being a health and care radical: change starts with me• The differences between trouble-makers and radicals• How to rock the boat and stay in it• How to be a great change agent
2. Forming communities: building alliances for change• The power of working together by exploring communities and social movements• Techniques for connecting with own/others’ values and emotions to create a call
for action
3. Rolling with resistance• Recognising behaviour, behaviour change and the importance of appreciating
where people are starting from in relation to change
4. Making change happen• A range of tools, tactics and ways to make change happen
5. Moving beyond the edge• Helping radicals to shape how they take their learning from The School forward• What we can do next and where else we might get support and resources
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The School is being formally evaluated by the Chartered Institute for Personnel & Development
#EdgeTalks WebEx
http://theedge.nhsiq.nhs.uk/expert/how-has-the-school-for-health-and-care-radicals-made-a-difference/
Or Google: #EdgeTalks School
How has the School for Health and Care Radicals made a difference?
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The School is being formally evaluated by the Chartered Institute for Personnel & Development
• Change knowledge• Sense of purpose & motivation to improve practice• Ability to challenge the status quo• Rocking the boat & staying in it• Connecting with others to build support for change
Statistically significant positive effect on EVERY dimension of impact at both individual
and organisational level
@HelenBevan @SteveFairman1 #cmidisrupt #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
@HelenBevan @SteveFairman1 #cmidisrupt #Expo15NHS #EdgeTalks @HelenBevan @JodiOlden
Activists from 120 countries
500,000+ Twitter impressions@theedgenhs
21,000 active users
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We have supported NHS Change Day for three years
• 800,000 pledges in 2014
• 6X the local activity/connectivity in 2015 compared to 2014
• #nhschangeday: 130m impressions
• Facebook impressions 253,999
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The Change Challenge
Tapping the collective brilliance of the NHS
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• The biggest-ever digital campaign for EMAP (Health Service Journal and Nursing Times)
• 14,000 contributors to the joint campaign to “challenge top down change”
• Ground-breaking: the first-ever crowd-sourced theory of change in the NHS
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Reach and scale:
• Contributors from 45 different countries
• 13,895 ideas, comments and votes shared - collectively identifying:
Final outputs were • 10 barriers• 11 building blocks• 16 solutions
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14,000 contributions identified 10 barriers to change:
Confusing strategies
Over controlling leadership
Perverse incentivesStifling innovation
Poor workforce planning
One way communication
Inhibiting environment
Undervaluing staff
Poor project management
Playing it safe
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Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on
Increasing number of messages as information cascade through
the organisation
Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx
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Front line teams get inundated with high priority messages from leaders each day, making it difficult for them to know what to focus on
Increasing number of messages as information cascade through
the organisation
Source: adapted from http://businessjournal.gallup.com/content/162707/change-initiatives-fail-don.aspx
Buy in from front line staff is critical for improvements in quality and safety . Don’t overload them
Buy in from front line staff is critical for improvements in quality and safety
Don’t overload themhttp
://healthaffairs.org/blog/2014/03/07/the-dangers-of-quality-improvement-overload-insights-from-the-field
/
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14,000 contributions identified 11 building blocks for change:
Inspiring & supportive leadershipCollaborative working
Thought diversityAutonomy & trust
Smart use of resources
Flexibility & adaptability
Long term thinking
Nurturing our people
Fostering an open culture
A call to action
Source: Health Service Journal, Nursing Times, NHS Improving Quality, “Change Challenge” March 2015
Challenging the status quo
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The power of the platform
“...demonstrates, yet again, the collective brilliance of the people who work in the NHS and wider care system”
@HelenBevan
@HelenBevan @SteveFairman1 #cmidisrupt
How to create a change platform #1• Be clear about your intention or goal:• Solve a problem?• Learn from others?• Create solutions?• Mobilise for change?• Spread innovation?
• Articulate your mission• Design the stages in your process• Sprints and hacks
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How to create a change platform #2• Identify the people you want in your community• Identify how to reach them• Find a platform • Existing or new • Free or paid for• Virtual or face to face
• Measure the outcomes (all the way through)• Engage your community• Set their expectations• Keep the connections flowing• Convert ideas to actions• Always, always follow up
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CAREDESIGN2016System redesign principles for care models
#CareDesign
“Help us to capture redesign principles for care models to get better, quicker outcomes from
change”
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New care models
• Viable smaller hospitals• Maternity services• Health of people in care
homes
• Multispecialty Community Provider
• Primary and Acute Care Systems
• Urgent and emergency care
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What are design principles?
“Design principles are suggestions that are highly likely to be effective, but they are not formulae that guarantee success … The point remains, however, that if one knows the design principles in a field, he or she is much further along in thinking and much more likely to be successful.”
Paul Bates
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@HelenBevan @SteveFairman1 #cmidisrupt
Our ‘starter-for-ten’
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”If people give to a cause, they expect a relationship, not a transaction”
Nilofer Merchant
Once you start down this path, you have to follow up and continue
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Platforms are only as good as the people leading them
Source of image: www.activationjourney.com
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Four ways to connect!
1. Follow us on Twitter@HelenBevan @SteveFairman1 @School4Radicals
2. Subscribe to theedge.nhsiq.nhs.uk
3. Get materials from theedge.nhsiq.nhs.uk/school
…and sign up for our monthly #EdgeTalkstheedge.nhsiq.nhs.uk/edgetalks
4. Save the date for theedge.nhsiq.nhs.uk/transformathon
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4pm - 4pm, 27-28th January 2016
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“Even the smallest creature can
change the world”Galadriel to FrodoLord of the Rings
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Ashoka (2014) What does leadership mean in the 21st century?Berg O (2014) The Collaboration Pyramid revisitedBriggs D (2015) The elements of council as a platformBromford P (2015) What’s the difference between a test and a pilot?Dawson R (2015) The future of work and organisations Deloitte University Press (2015) Business ecosystems come of ageDeloitte University Press (2014) The power of platformsHagel J (2015) John Hagel at SXSW 2015: Narratives, platforms and movementsHagel J (2014) Platforms are not created equal: harnessing the full potential of platformsHamel G, Zanini J (2014) Build a change platform not a change programHealth Services Journal, Nursing Times, NHS Improving Quality (2015) ‘Change Challenge’ interactive toolkitHeimans J (2014) What new power looks like [YouTube]Heimens J, Timms J (2014) Understanding “New Power”Innovations- Kontor Väst (2013) Open innovation – a handbook for Researchers Ivanov E (2013) The Strength Within
References cited in the slide deck (1/2)
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Jarche H (2014) The Seek > Sense > Share Framework Milton N (2014) Why knowledge transfer through discussion is 14 times more effective than writingO’Reilly T (2010) Government as a platformPearce D (2013) Social business discussions are the new documentationRaymond E S (2001) The Cathedral and the BazaarSatell G (2015) 4 things you should know about platformsSatell G (2012) How power is shifting from corporations to platformsSatell G (2015) Leaders must do more than inspire – we must shape networksSchillinger C (2015) Forget social networks, think social impact [YouTube]Scrivens J (2015) Enabling the experience of wholeness within enterprise social networksSewell S (2015) Stop training our project managers to be process junkiesShaw K (2015) Placing a digital platform at the heart of organisational change with OxfamSimon P (2011) The Age of the Platform
References cited in the slide deck (2/2)